Verbal apraxia; Dyspraxia; Speech disorder - apraxia; Childhood apraxia of speech; Apraxia of speech; Acquired apraxia
Last reviewed: August 29, 2012.
Apraxia is a disorder of the brain and nervous system in which a person is unable to perform tasks or movements when asked, even though:
The request or command is understood
They are willing to perform the task
The muscles needed to perform the task work properly
The task may have already been learned
Causes, incidence, and risk factors
Apraxia is caused by damage to the brain. When apraxia develops in a person who was previously able to perform the tasks or abilities, it is called acquired apraxia.
The most common causes of acquired apraxia are:
Brain tumor
Condition that causes gradual worsening of the brain and nervous system (neurodegenerative illness)
Dementia
Stroke
Traumatic brain injury
Apraxia may also be seen at birth. Symptoms appear as the child grows and develops. The cause is unknown.
Apraxia of speech is often present along with another speech disorder called aphasia. Depending on the cause of apraxia, a number of other brain or nervous system problems may be present.
Symptoms
A person with apraxia are unable to put together the correct muscle movements. At times, a completely different word or action is used than the one the person intended to speak or make. The person is often aware of the mistake.
Symptoms of apraxia of speech include :
Speech sounds and words may be distorted, repeated, or left out. It is difficult to put words together in the correct order.
Struggling to pronounce the right word.
Longer words are more difficult to use, either at all, or from one time or another.
Short everyday phrases or sayings (such as "How are you?") can often still be used without a problem.
The person often can write better than he or she can speak.
Other forms of apraxia include:
Buccofacial or orofacial apraxia: Cannot carry out movements of the face on demand, such as licking the lips, sticking out the tongue, or whistling.
Ideational apraxia: Cannnot carry out learned complex tasks in the proper order, such as putting on socks before putting on shoes.
Ideomotor apraxia: Cannot voluntarily perform a learned task when given the necessary objects. For instance, if given a screwdriver, the person may try to write with it as if it were a pen.
Limb-kinetic apraxia: This condition involves difficulty making precise movements with an arm or leg. It becomes impossible to button a shirt or tie a shoe.
Frustration, profanity, and depression are typical responses in persons with aphasia.
Signs and tests
The following tests may be performed if the cause of the disorder is not known:
CT or MRI scans of the brain may help show a tumor, stroke, or other brain injury
An electroencephalogram (EEG) may be used to rule out epilepsy as a cause of the apraxia.
A spinal tap may be done to check for inflammation or an infection that affects the brain.
Standardized language and intellectual tests should be done if apraxia of speech is suspected. Testing for other learning disabilities may also be needed.
Treatment
Occupational and speech therapists may help both patients and their caregivers learn ways to deal with the apraxia. However, because people with apraxia have trouble following instructions, occupational therapy is difficult.
Speech and language treatment may include:
Repeating sounds over and over in order to teach mouth movements
Learning to slow down how the person talks
Different techniques to help with communication
Recognition and treatment of depression is important for people with severe speech and language disorders.
Other tips:
Maintain a relaxed, calm environment.
Take time to show someone with apraxia how to do a task, and allow enough time for them to do so. Do not ask them to repeat the task if they are clearly struggling with it and doing so will increase frustration.
Suggest alternative ways to do the same things, for example, try a hook and loop closure instead of laces for shoes.
When speech apraxia is present:
Avoid giving complex directions.
Use simple phrases to avoid misunderstandings.
Speak in a normal tone of voice. Speech apraxia is not a hearing problem.
Don't assume that the person understands.
Provide communication aids, if possible, depending on the person and condition.
Expectations (prognosis)
Many people with apraxia are no longer able to be independent and may have trouble performing everyday tasks. Ask your healthcare provider, which activities may or may not be safe. Avoid activities that may cause injury, and take the proper safety measures.
Complications
Learning problems
Low self-esteem
Social problems
Calling your health care provider
Contact your health care professional if someone has difficulty performing everyday tasks or has other symptoms of apraxia after a stroke or brain injury.
Prevention
Reducing your risk for stroke and brain injury may help prevent conditions that lead to aphasia.
References
Swanberg MM, Nasreddine ZS, Mendez MF, Cummings JL. Speech and language. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 6.
Kortte JH, Palmer JB. Speech and language disorders. In: Frontera, WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 145.
Here are some of the tactile cues and names for the sounds
Tactile/Visual Cues for Speech Sounds
Some children benefit from a multi-sensory approach to phonological development. Sometimes “seeing” a sound paired with a gestural touch cue can help a child notice the sound, identify it, or produce it clearly. These touch cues, when used along with the sound, can help the child recognize the presence of the sound, where it is made (how the lips, tongue, jaw are positioned), where the sound can be felt (for example, “k” and “g” can be felt by touching your throat), and how it made (a staccato sound, such as “b” or a continuous sound, such as “s”). You will notice that sounds that are similar (f,v; s/z; t/d; k,g; ch, j) also have similar touch cues. How to use these tactile cues: Use them to call attention to a sound in a word. For example, if you want your child to make a “k” sound or identify that several words all start with “k”, you will use the touch cue for that sound as you say the words. Do not worry about using the touch cue for each sound, just the one that you really want your child to pay attention to. Do the same thing if you are emphasizing the last sound in the word-just use that cue when you say that sound. Do not worry if your cue is a little different from the one in the directions. Just be consistent each time you use it. While it is not necessary for your child to use the touch cues when he or she makes
/p/ and /b/ “Popping sound” /p/- Touch the lower lip with your index finger. Pull your finger slightly away from the lips as you say the sound. /b/ - Touch the lower lip with your index finger. Use your full hand (in ‘b’ shape) covering both lips for /b/.
/t/ and /d/ “Snappy sound” Touch your lower lip lightly with your index finger and pull quickly away from your mouth as you say the sound.
/n/ and /m/ “Nose sound” /m/- index finger and thumb pinched together beside lips to indicate closed lips. /n/ - point to your tongue just behind upper teeth.
/k/ and /g/ “Back sound” Place your index finger under the chin above the larynx, and remove your hand as you say the sound.
/s/ and /z/ “Snake sound” Hold your hand, in the ‘s’ alphabet shape (closed fist with thumb in front along the knuckles) beside your mouth while you say the sound.
/f/ and /v/ “Blowing sound” Place four fingers on your chin and remove as you say the sound.
/l/ “Tongue up” Use the index finger of the ‘l’ alphabet shape to point to your tongue just behind your upper teeth.
/w/ “Lips out” Circle your lips with the index finger as you say the sound.
“sh” and “zh” “Be quiet sound” Index finger in front of protruded lips (as if saying “ssshhh”).
“ch” and “dj” “Sneezing sound” Index finger in front of protruded lips, pull away quickly as you say the sound.
“th” and “th” “Tongue out” Point to the tip of your tongue protruded between upper and lower teeth.
/r/ “Growling sound” Place the thumb and middle finger on opposite cheeks approximately at the upper molar positions.
/j/ (y) Use the /r/ tactile cue but also quickly draw the fingers down to suggest opening while you produce the sound.
This is the PECS PowerPoint.
Phase 1
http://www.youtube.com/watch?v=ZP48lxnNdHM&safety_mode=true&persist_safety_mode=1&safe=active
Phase 2
http://www.youtube.com/watch?v=tr3lQXNEcps&feature=mfu_in_order&list=UL&safety_mode=true&persist_safety_mode=1&safe=active
Apraxia
http://www.youtube.com/watch?v=WVHu1-OjAsw&feature=related&safety_mode=true&persist_safety_mode=1&safe=active
http://www.youtube.com/watch?v=szjfC9K190U&list=UUmU3d4B8gxd0nXVEG7YkdmQ&index=16&feature=plcp&safety_mode=true&persist_safety_mode=1&safe=active
http://www.youtube.com/watch?v=Lvl78dcXGp8&list=PL599B4FCE5F6A7A21&index=93&feature=plpp_video&safety_mode=true&persist_safety_mode=1&safe=active
Apraxia
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004944/
The below is from A.D.A.M. Medical Encyclopedia
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004944/
Apraxia
Verbal apraxia; Dyspraxia; Speech disorder - apraxia; Childhood apraxia of speech; Apraxia of speech; Acquired apraxiaLast reviewed: August 29, 2012.
Apraxia is a disorder of the brain and nervous system in which a person is unable to perform tasks or movements when asked, even though:
Causes, incidence, and risk factors
Apraxia is caused by damage to the brain. When apraxia develops in a person who was previously able to perform the tasks or abilities, it is called acquired apraxia.The most common causes of acquired apraxia are:
- Brain tumor
- Condition that causes gradual worsening of the brain and nervous system (neurodegenerative illness)
- Dementia
- Stroke
- Traumatic brain injury
Apraxia may also be seen at birth. Symptoms appear as the child grows and develops. The cause is unknown.Apraxia of speech is often present along with another speech disorder called aphasia. Depending on the cause of apraxia, a number of other brain or nervous system problems may be present.
Symptoms
A person with apraxia are unable to put together the correct muscle movements. At times, a completely different word or action is used than the one the person intended to speak or make. The person is often aware of the mistake.Symptoms of apraxia of speech include :
- Speech sounds and words may be distorted, repeated, or left out. It is difficult to put words together in the correct order.
- Struggling to pronounce the right word.
- Longer words are more difficult to use, either at all, or from one time or another.
- Short everyday phrases or sayings (such as "How are you?") can often still be used without a problem.
- The person often can write better than he or she can speak.
Other forms of apraxia include:- Buccofacial or orofacial apraxia: Cannot carry out movements of the face on demand, such as licking the lips, sticking out the tongue, or whistling.
- Ideational apraxia: Cannnot carry out learned complex tasks in the proper order, such as putting on socks before putting on shoes.
- Ideomotor apraxia: Cannot voluntarily perform a learned task when given the necessary objects. For instance, if given a screwdriver, the person may try to write with it as if it were a pen.
- Limb-kinetic apraxia: This condition involves difficulty making precise movements with an arm or leg. It becomes impossible to button a shirt or tie a shoe.
Frustration, profanity, and depression are typical responses in persons with aphasia.Signs and tests
The following tests may be performed if the cause of the disorder is not known:- CT or MRI scans of the brain may help show a tumor, stroke, or other brain injury
- An electroencephalogram (EEG) may be used to rule out epilepsy as a cause of the apraxia.
- A spinal tap may be done to check for inflammation or an infection that affects the brain.
Standardized language and intellectual tests should be done if apraxia of speech is suspected. Testing for other learning disabilities may also be needed.Treatment
Occupational and speech therapists may help both patients and their caregivers learn ways to deal with the apraxia. However, because people with apraxia have trouble following instructions, occupational therapy is difficult.Speech and language treatment may include:
- Repeating sounds over and over in order to teach mouth movements
- Learning to slow down how the person talks
- Different techniques to help with communication
Recognition and treatment of depression is important for people with severe speech and language disorders.Other tips:
- Maintain a relaxed, calm environment.
- Take time to show someone with apraxia how to do a task, and allow enough time for them to do so. Do not ask them to repeat the task if they are clearly struggling with it and doing so will increase frustration.
- Suggest alternative ways to do the same things, for example, try a hook and loop closure instead of laces for shoes.
When speech apraxia is present:Expectations (prognosis)
Many people with apraxia are no longer able to be independent and may have trouble performing everyday tasks. Ask your healthcare provider, which activities may or may not be safe. Avoid activities that may cause injury, and take the proper safety measures.Complications
Calling your health care provider
Contact your health care professional if someone has difficulty performing everyday tasks or has other symptoms of apraxia after a stroke or brain injury.Prevention
Reducing your risk for stroke and brain injury may help prevent conditions that lead to aphasia.References
Review Date: 8/29/2012.
http://www.apraxia-kids.org/site/apps/nl/content3.asp?c=chKMI0PIIsE&b=788447&ct=1212055
This website gives instruction for apraxia treatment.
http://www.apraxia-kids.org/site/apps/nlnet/content3.aspx?c=chKMI0PIIsE&b=699375&ct=3545757¬oc=1
This is an article with suggested books that have repetitive lines in them to assist in apraxic treatment.
The below is EXCELLENT resource.
[PPT]
Childhood and //**Apraxia**// of Speech (Therapy Ideas) - CAS: Assessment **...**
http://www.ndsccenter.org/resources/documents/speech/Kumin.Apraxia.pdf
http://www.childdevelopmentinfo.com/development/language_development.shtml
Childhood Apraxia
http://www.showmemsha.org/continuing-ed/convention/handouts/C7-9.pdf
Excellent review with treatment suggestions
Here are some of the tactile cues and names for the sounds
Tactile/Visual Cues for Speech Sounds
Some children benefit from a multi-sensory approach to phonological development. Sometimes “seeing” a sound
paired with a gestural touch cue can help a child notice the sound, identify it, or produce it clearly. These touch
cues, when used along with the sound, can help the child recognize the presence of the sound, where it is made
(how the lips, tongue, jaw are positioned), where the sound can be felt (for example, “k” and “g” can be felt by
touching your throat), and how it made (a staccato sound, such as “b” or a continuous sound, such as “s”). You will
notice that sounds that are similar (f,v; s/z; t/d; k,g; ch, j) also have similar touch cues.
How to use these tactile cues: Use them to call attention to a sound in a word. For example, if you want your child
to make a “k” sound or identify that several words all start with “k”, you will use the touch cue for that sound as
you say the words. Do not worry about using the touch cue for each sound, just the one that you really want your
child to pay attention to. Do the same thing if you are emphasizing the last sound in the word-just use that cue
when you say that sound. Do not worry if your cue is a little different from the one in the directions. Just be
consistent each time you use it. While it is not necessary for your child to use the touch cues when he or she makes
/p/ and /b/ “Popping sound”
/p/- Touch the lower lip with your index finger. Pull your finger slightly away from the lips as you say the sound.
/b/ - Touch the lower lip with your index finger. Use your full hand (in ‘b’ shape) covering both lips for /b/.
/t/ and /d/ “Snappy sound”
Touch your lower lip lightly with your index finger and pull quickly away from your mouth as you say the sound.
/n/ and /m/ “Nose sound”
/m/- index finger and thumb pinched together beside lips to indicate closed lips.
/n/ - point to your tongue just behind upper teeth.
/k/ and /g/ “Back sound”
Place your index finger under the chin above the larynx, and remove your hand as you say the sound.
/s/ and /z/ “Snake sound”
Hold your hand, in the ‘s’ alphabet shape (closed fist with thumb in front along the knuckles) beside your mouth while you say the sound.
/f/ and /v/ “Blowing sound”
Place four fingers on your chin and remove as you say the sound.
/l/ “Tongue up”
Use the index finger of the ‘l’ alphabet shape to point to your tongue just behind your upper teeth.
/w/ “Lips out”
Circle your lips with the index finger as you say the sound.
“sh” and “zh” “Be quiet sound”
Index finger in front of protruded lips (as if saying “ssshhh”).
“ch” and “dj” “Sneezing sound”
Index finger in front of protruded lips, pull away quickly as you say the sound.
“th” and “th” “Tongue out”
Point to the tip of your tongue protruded between upper and lower teeth.
/r/ “Growling sound”
Place the thumb and middle finger on opposite cheeks approximately at the upper molar positions.
/j/ (y) Use the /r/ tactile cue but also quickly draw the fingers down to suggest
opening while you produce the sound.
/h/ “Breathy sound”
Move palm open hand up the neck as you produce the sound.
http://www.latrobe.edu.au/hcs/resources/cas/docs/tips-making-soundscards.pdf
This is a great site with visuals for the sounds and their names that could be cut out and given to a family to practice with.
http://everythingspeech.com/treatment/apraxia-treatment/
This site also has some great treatment approaches and the sequence to do them in.
http://people.umass.edu/velleman/cas.html
Good summary of Apraxia
http://www.apraxia-kids.org/
Excellent reference
http://www.apraxia-kids.org/site/apps/nl/content3.asp?c=chKMI0PIIsE&b=788449&ct=910955
literacy and dyspraxia
http://www.ohioslha.org/pdf/Convention/2011%20Handouts/SC16SpeechFishC.pdf
Excellent article on apraxia and has pictures of hand cues
http://www.txsha.org/_pdf/Convention/2012Convention/2012Handouts/Carahaly,%20Lynn%20-%20Using%20Symbolic%20Gestures%20to%20Facilitate%20Speech%20Motor%20Planning%20and%20Literacy%20Development.pdf